Setting higher standards for migraine prevention: A position statement of the International Headache Society

Migraine is one of the most prevalent and disabling neurological diseases, significantly affecting quality of life and productivity, as well as contributing to substantial societal costs. Recent innovations, including calcitonin gene-related peptide (CGRP) pathway inhibitors and onabotulinumtoxinA, have transformed migraine prevention by offering high efficacy and excellent tolerability, thus improving adherence. Clinical trials and real-world studies show that significant reductions in migraine frequency and, in some cases, complete migraine freedom is achievable. In this Position Statement, we advocate for raising the standards of migraine prevention by setting ambitious treatment goals aimed at optimal outcomes, such as migraine freedom or very low number of days with migraine or moderate/severe headache. We emphasize the importance of addressing residual migraine burden, highlighting that achieving a ≥50% reduction in monthly migraine days, although often considered a successful response, may not fully restore quality of life. Relying solely on percentage-based improvements can obscure the persisting impact of residual burden. This Position Statement does not want to change the standards for clinical trials but aims primarily at real-world clinical practice and proposes a shift from percentage-based measures of success to absolute goals while on treatment. We outline a framework that categorizes outcomes into four tiers: migraine freedom (no days with migraine or moderate-to-severe headache), optimal control (less than four days with migraine or moderate-to-severe headache), modest control (four to six days with migraine or moderate-to-severe headache) and insufficient control (more than days with migraine or moderate-to-severe headache). Focusing on residual burden while on treatment aims to further improve patient quality of life and drive innovation in preventive therapies and non-pharmacological approaches. By advocating for higher standards, this Position Statement, is not aimed primarily to drive reimbursement policies for migraine preventive treatments, but seeks to inspire clinicians, researchers and policymakers to prioritize ambitious goals in migraine prevention, ultimately enhancing patient outcomes and reducing the broader societal and economic impact of this debilitating condition.

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Publication Details

Journal
Cephalalgia
Published
2025-02-01
DOI
https://doi.org/10.1177/03331024251320608
Citations
40
Primary Topic
Migraine and Headache Studies
Type
article
Field-Weighted Citation Impact
58.85

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article

Setting higher standards for migraine prevention: A position statement of the International Headache Society

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40 citations
Cephalalgia
Migraine and Headache Studies
58.85
article

Setting higher standards for migraine prevention: A position statement of the International Headache Society

Mi Ji Lee, Fayyaz Ahmed, Fumihiko Sakai, Francesca Puledda, Teshamae Monteith, Todd J. Schwedt, Messoud Ashina, Shuu‐Jiun Wang, Faraidoon Haghdoost, Hans‐Christoph Diener, Patricia Pozo‐Rosich, Simona Sacco, Cristina Tassorelli, Gisela M. Terwindt, Raffaele Ornello, Gloria Vaghi, Mário Fernando Prieto Peres, Bronwyn Jenkins
article en
40 citations

Abstract

Migraine is one of the most prevalent and disabling neurological diseases, significantly affecting quality of life and productivity, as well as contributing to substantial societal costs. Recent innovations, including calcitonin gene-related peptide (CGRP) pathway inhibitors and onabotulinumtoxinA, have transformed migraine prevention by offering high efficacy and excellent tolerability, thus improving adherence. Clinical trials and real-world studies show that significant reductions in migraine frequency and, in some cases, complete migraine freedom is achievable. In this Position Statement, we advocate for raising the standards of migraine prevention by setting ambitious treatment goals aimed at optimal outcomes, such as migraine freedom or very low number of days with migraine or moderate/severe headache. We emphasize the importance of addressing residual migraine burden, highlighting that achieving a ≥50% reduction in monthly migraine days, although often considered a successful response, may not fully restore quality of life. Relying solely on percentage-based improvements can obscure the persisting impact of residual burden. This Position Statement does not want to change the standards for clinical trials but aims primarily at real-world clinical practice and proposes a shift from percentage-based measures of success to absolute goals while on treatment. We outline a framework that categorizes outcomes into four tiers: migraine freedom (no days with migraine or moderate-to-severe headache), optimal control (less than four days with migraine or moderate-to-severe headache), modest control (four to six days with migraine or moderate-to-severe headache) and insufficient control (more than days with migraine or moderate-to-severe headache). Focusing on residual burden while on treatment aims to further improve patient quality of life and drive innovation in preventive therapies and non-pharmacological approaches. By advocating for higher standards, this Position Statement, is not aimed primarily to drive reimbursement policies for migraine preventive treatments, but seeks to inspire clinicians, researchers and policymakers to prioritize ambitious goals in migraine prevention, ultimately enhancing patient outcomes and reducing the broader societal and economic impact of this debilitating condition.

CephalalgiaVol. 45(2)
Universitat Autònoma de Barcelona (ES), University of Copenhagen (DK), University of Miami (US), National Yang Ming Chiao Tung University (TW), King's College London (GB), University of Pavia (IT), University of L'Aquila (IT), Leiden University Medical Center (NL), Royal North Shore Hospital (AU), Hospital Israelita Albert Einstein (BR), WinnMed (US), Copenhagen University Hospital (DK), Foundation Center (US), Rigshospitalet (DK), Seoul National University Hospital (KR), Taipei Veterans General Hospital (TW), UNSW Sydney (AU), Institut für Medizinische Informatik, Biometrie und Epidemiologie (DE), Fondazione Istituto Neurologico Nazionale Casimiro Mondino (IT), Vall d'Hebron Institut de Recerca (ES), Urology Foundation (GB), The George Institute for Global Health (AU), Vall d'Hebron Hospital Universitari (ES), Saitama International Medical Center (JP), Mayo Clinic in Florida (US), Hull York Medical School (GB)
U.S. Department of Defense, American Heart Association, Amgen, Eli Lilly and Company, Pfizer, Sanofi, Biogen, Patient-Centered Outcomes Research Institute, Teva Pharmaceutical Industries, Fondazione Italiana Sclerosi Multipla, International Headache Society, Massachusetts Medical Society, Neuroscience Research Australia, American Headache Society, Yuhan, European Commission, National Research Foundation, Seoul National University, Shanghai Educational Development Foundation, Daiichi-Sankyo, Ministero della Salute, Nederlandse Organisatie voor Wetenschappelijk Onderzoek, National Research Foundation of Korea, Ministry of Education, India, Ministerio de Ciencia e Innovación, Stichting Dioraphte, Taipei Veterans General Hospital, H. Lundbeck A/S, Ipsen, National Institutes of Health, Allergan, Agència de Gestió d'Ajuts Universitaris i de Recerca
Decent work and economic growth
Openalex Percentile: Top 0%
Migraine and Headache Studies
58.85
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